Nae-Fong Twu

Prognostic nomogram for overall survival in stage IIB-IVA cervical cancer patients treated with concurrent chemoradiotherapy.

OBJECTIVE On the basis of outcome data from concurrent chemoradiotherapy (CCRT) for locally advanced cervical squamous cell carcinoma, the authors developed a nomogram for predicting survival outcome. STUDY DESIGN Two hundred fifty-one eligible patients with International Federation of Gynecology and Obstetrics stage IIB-IVA squamous cell carcinoma of the uterine cervix who underwent CCRT were included for the construction of the nomogram. Predictor variables included age, serum squamous cell carcinoma antigen, tumor size, parametrium invasion, hydronephrosis, bladder/rectum invasion, and lymph node metastases. Internal validation of the nomogram was performed. RESULTS A nomogram for predicting the 5 year overall survival for these patients was constructed on the basis of a Cox regression model from 7 parameters. The concordance index was 0.69. CONCLUSION This nomogram is a predictive tool, upon external validation, that can be used to counsel patients in predicting outcomes. The discriminatory ability of the nomogram indicates that this population should not be considered homogeneous with respect to risk of death.

Impact of pregnancy on primary dysmenorrhea

Objective: Because it has been observed that dysmenorrhea can improve after childbirth, this investigation was intended to quantify the impact of both gestational length and mode of delivery on primary dysmenorrhea. Methods: This is an 8‐year prospective observational study. Patients with a history of dysmenorrhea who later gave birth were evaluated for improvement on the severity of dysmenorrhea, with use of visual analogue scale (VAS), and Likert‐type scale. Result: Final analysis involved 3694 patients. Women who had spontaneous delivery would have significantly more improvement than women with cesarean delivery per VAS (term delivery, 51 vs. 33, P < 0.001; preterm delivery, 17 vs. 10, P < 0.001). For first delivery, patients in the spontaneous delivery subgroup were the most likely to have improvement in severity of dysmenorrhea. For second delivery, only patients in the spontaneous delivery subgroup had statistically significant improvement. Conclusion: Both length of gestation and mode of delivery have an impact on primary dysmenorrhea. The most significant improvement occurred after the first delivery.

Importance of delivered cycles and nomogram for intraperitoneal chemotherapy in ovarian cancer

OBJECTIVE Intraperitoneal (IP) chemotherapy has gained enthusiasm in the treatment of ovarian cancer. Despite having a better survival advantage than intravenous (IV) chemotherapy, IP chemotherapy still poses significant morbidity and complications. Identifying the subset of patients who could best benefit from IP chemotherapy, and those who would least benefit from this treatment, thus avoiding potential complications, is critical. METHODS Between January 2001 and December 2007, 367 patients with stage III epithelial ovarian cancer underwent randomized trial for IP/IV chemotherapy were recruited to construct a nomogram, which is a graphical representation of Cox proportional hazards model adopting six weighted risk factors including age, CA125, IP/IV delivery, stage, histology, and upper abdominal metastases. The nomogram was internally validated for discrimination and calibration. The concordance index was used for quantifying the predictive ability of overall survival with bootstrapping to correct for bias. RESULTS The cycles of completed IP chemotherapy had an impact on overall survival (> or =5 vs. < or =4 cycles, P=0.02). A nomogram for predicting median survival and 5-year survival probability was constructed with a concordance index of 0.72. Upper abdominal tumor metastases (P<0.001) and colon resection (P=0.02) predicted increased chances for early discontinuation of IP chemotherapy. CONCLUSIONS At least five IP cycles are needed to achieve better survival. Nomogram can help to identify the subset of patients who can least benefit from IP chemotherapy, thus avoiding potential IP complications and help to facilitate discussion between patient and physician, risk stratification, and help to guide clinical care.

Parametrial tumor spreading patterns in cervix cancer patients treated by radical hysterectomy

Objectives: To evaluate tumor‐spreading patterns in the parametrium. Methods: We conducted a prospective clinical trial between January 1998 and December 2000 to define a new method for parametrium evaluation. The parametrium was divided into three areas, paracorpus, paracervix, and paravagina. A total of 284 consecutive patients with FIGO stage IB to IIA cervical cancer who had undergone radical hysterectomy were considered for the study. Results: Of the 262 patients who were found eligible for evaluation, 135 had histopathologic analysis performed according to the new method and 127 with the traditional method. The detection of rate of parametrial invasion was 36 (26.7%) with the new and 13 (10.2%) with the traditional method (P=0.0014). The frequency of pelvic lymph node metastasis was 66.7% in patients who had tested positive for invasion of the paracorpus, 57.7% in those who had tested positive for invasion of the paracervix, and 71.4% in those who had tested positive for invasion of the paravagina. The frequency of pelvic lymph node metastasis in patients who had tested negative for invasion of the paracorpus, paracervix, or paravagina was 4.0%. Tumor cells tend to spread laterally and inferiorly in the parametrium. Conclusions: Using our classification of three parametrium areas for histologic examination can increase the detection rates of parametrial tumor invasion and help prevent failure of local treatment by allowing to implement appropriate adjuvant therapy.

Comparison of single-incision mini-slings (Ajust) and standard transobturator midurethral slings (Align) in the management of female stress urinary incontinence: A 1-year follow-up.

OBJECTIVE To investigate the effectiveness and safety of a new single-incision mini-sling (SIMS)-Ajust-compared with the standard transobturator midurethral sling (SMUS)-Align-for the treatment of female stress urinary incontinence (SUI). MATERIALS AND METHODS A retrospective cohort study was conducted between January 1, 2010 and August 31, 2012. Women with SUI who underwent either SMUS-Align or SIMS-Ajust were recruited. The primary outcomes included operation time, estimated operative blood loss, postoperative pain, and complications. The secondary outcomes included subjective and objective success, defined as an International Consultation on Incontinence Questionnaire (ICIQ) score of 0 or improvement as felt by the patient and a long-term complication, such as dyspareunia and mesh erosion after 6 months and 12 months of follow-up. RESULTS A total of 136 patients were enrolled, including 76 receiving SMUS-Align and 60 receiving SIMS-Ajust. Baseline characteristics of the patients in both groups were similar, without a statistically significant difference. Primary outcomes between both groups were similar, except that women treated with SIMS-Ajust had statistically significantly shorter operation time (p = 0.003), less intent to treat (p < 0.05), and earlier postoperative discharge (p = 0.001) than women treated with SMUS-Align. Secondary outcomes were similar without a significant difference between the two groups (93% vs. 88% success rate in each group). CONCLUSION Our results showed that SIMS-Ajust was not inferior to SMUS-Align with respect to success rate, and might have a slight advantage in early discharge. A long-term follow-up or prospective study is needed to confirm the above findings.

Investigation of Serum CA125 Distribution Pattern in Uterine Leiomyoma and Uterine Leiomyosarcoma

Purpose Most comparisons between uterine leiomyoma and uterine leiomyosarcoma were based on postoperative pathological or molecular analyses. Very few reports have been investigated preoperative differentiation between uterine leiomyoma and uterine leiomyosarcoma. Methods Between January 1990 and December 2003, 42 consecutive patients with uterine leiomyosarcoma treated at the index hospitals were analyzed. Meanwhile, 84 patients with uterine leiomyomas were used as controls. The author evaluated diagnostic performance of preoperative serum CA125 for the differential diagnosis between uterine leiomyoma and uterine leiomyosarcoma using receiver operating characteristic (ROC) curves. Data presentations were categorized into premenopausal group and postmenopausal group. Diagnostic efficiency was calculated as the sensitivity multiplied by the specificity. Results Values of preoperative serum CA125 were significantly higher in the uterine leiomyosarcoma group than those in the uterine leiomyoma group. There was significant overlapping of preoperative serum CA125 between uterine leiomyoma group and early stage uterine leiomyosarcoma. For both premenopausal and postmenopausal group, there was significant difference in the distribution of preoperative serum CA125 in early stage and advanced stage uterine leiomyosarcoma. The optimal cutoff values of serum CA125 for the premenopausal group and postmenopausal group was 162 U/mL and 75 U/mL, respectively. Conclusion These findings demonstrated that preoperative serum CA125 had a potential role in the differential diagnosis between early stage and advanced stage uterine leiomyosarcoma. Further investigation with larger sample size at adequate power is necessary to verify the current study.

Correlation between Ascites and Serum CA125 in Patients with Ovarian Cancer

Objective Ovarian cancer is the second most common gynecologic cancer and remains the major cause of death for gynecologic malignancy. The aim of this study was to evaluate the role of preoperative serum CA-125 level and volume of ascites for prognostic prediction. Methods This study was a prospective non-randomized study. 110 patients with advanced stage epithelial ovarian cancer after primary debulking surgery between 1995 and 2000 were enrolled. CA-125 blood samples were collected preoperatively for each recruited patient and assayed using radioimmunoassay method. Volume of ascites was recorded intraoperatively. Ascites was defined if the peritoneal fluid was more than 100 cc. Results. A total of 96 patients were eligible for evaluation. The 5-year overall survival in the ascites group was 46% versus 34% in the no-ascites group (P=0.245, log-rank test). However, patients had poorer overall survival if ascites volume was more than 500 ml (P=0.044, log-rank test). The preoperative serum CA-125 was significantly higher in the ascites group (Mean±SEM, 1107±134 U/ml) than in the no-ascites group (Mean±SEM, 351±103 U/ml). Cox regression analysis showed extent of residual disease and serum CA-125 were two independent prognostic factors. Conclusion Ascites was a common finding in patients with advanced ovarian cancer. Pre-operative serum CA-125 was statistically significant higher in the ascites group than that in the no-ascites group. Univariate analysis showed poorer prognosis when ascites was more than 500 ml, but the role failed to exist after multivariate analysis.